January 2020

News of a mystery virus linked to a live animal market emerges. At first, one heard about it on BBC; it took a while to penetrate US news media. I was in between two international trips—I had just come back from India and had a scheduled bike vacation to Vietnam for mid-February. So, it was more for personal interest I started following the spread of the virus, which acquired a name SARS-COV2. Soon there were reports of “the novel corona virus” on the news. Even though Temple started thinking about the response at an administrative level, I do not think any of us seeing patients in clinic envisioned that our lives would be disrupted within the matter of a few months. Since Vietnam still looked safe enough, off I went on another bike adventure. Interestingly, cases in Vietnam were few and far between yet everyone wore a mask. Same in Cambodia.

Photo by Anuradha Paranjape

Fast Forward to February 22, 2020

I had just landed home after my trip. South Korea’s cases had just skyrocketed and the grip of the virus on the world’s people and economy started to tighten. Looking back now to early March, I remember being mildly peeved that I would not be able to travel in the short term. The thought that I would not see my ACLGIM and SGIM colleagues and friends seemed unthinkable and improbable. Now that peevishness seems selfish and a first-world problem.

By the first week of March, the virus seemed to be more than just a problem at a nursing home in the state of Washington. The first few cases had appeared in New York and the New York Times reported that approximately 2,000 people were quarantined. That alarmed me. Enough to cancel my weekend in New York City with friends and actually stock up on—yes—toilet paper but also most non-perishables. And no, I did not have an insider tip from anyone. I had been following the Hopkins GIS data map that had been highlighting the alarming spread of the virus across Europe. It was only a matter of time that the first case in metro Philadelphia would be reported, and it was reported a mere week later. Life as we knew it was about to change.

It Is Now April

I am really proud of our health system’s response to the pandemic. By the middle of March, our COVID screening clinic was up and running, all elective procedures were cancelled, office visits were converted phone or video visits, and outpatient traffic was markedly reduced. Visitors were not allowed outside of rare exceptions for birth and death. One building converted to COVID floors with added ICU capacity. Interestingly, and sometimes to my frustration, some people took a little longer to convince than others that we were planning for a potential disaster. But by the time the “all hands deck” call went out, people were expecting it. Physicians from all fields are now staffing the COVID floors, sometimes outside of their comfort zone, side by side with hospitalist colleagues. To quote a sub-specialty colleague: “Put me wherever you need me, just tell me what I need to know to staff it.”

I am equally proud of the Philadelphian and Pennsylvanian response. A stay at home order was issued for Metro Philadelphia shortly after the first cases were reported. The new normal now includes queues with social distancing to enter Trader Joe’s; community groups rapidly collecting masks for health care workers; people making masks, more people out for walks even when it is not sunny and warm. Random gestures of kindness by strangers and neighbors—my faith in humanity has been restored.

All that I have written so far is not new to anyone reading the Forum. I do have to say that the speed and agility that both leaders in medicine and healthcare workers on the front line demonstrated in adopting to the new normal has been amazing. What would have taken weeks or months even has been done in days—including setting up and modifying protocols for outpatient and inpatient care, getting billing codes, and accompanying documentation recommendation out to the physicians and staff, operationalizing telehealth visits, and more. Philadelphia city leaders called on our university to use the Liacouras Center, normally the venue for NCAA games, to be a field hospital for the city. Temple said “yes” without hesitation. Or asking for rent.

Personally, as a bicultural person whose family is not in this time zone, the hardest part is the unknown—when can I see my parents in India again? When can I travel to San Diego to see the family? But, on the other hand, there has been an unexpected upside. I’m even more connected to with friends and family than before—we check in on each other by phone, Whatsapp, and texting and I’ve reconnected with classmates from medical school. Imagine what a shelter in place order might have been 20 years ago? Although social media has been blamed a lot, it is social media and our devices that provide connection during times of social distancing.

Finally, I would like to share my three wishes for our post-pandemic future:

1. Let us not work sick again. Chiefs and chairs need to build a reserve for faculty so that physicians do not come in sick—most of us have worked sick because we did not want to burden our colleagues. Self-care is important, and social distancing when sick is actually a benefit to the health care system.
2. Let telehealth visits for vulnerable patients become a part of visit types. Just like Medicare was introduced as a concept in 1960 and now is a permanent part of our health care and social fabric, telehealth needs to remain an option for care.
3. May work-at-home policies become standard across healthcare systems as they are in the tech industry. Work-at-home policies allow families and individuals to flex their work hours to meet personal needs and actually when used thoughtfully, result in a more productive workplace.